Health funds to discuss covering costs of cochlear implants

KEN RICE, PATIENT: If would be extremely frustrating, it would make me extremely angry if I realised that there were some technology that was within my reach but for some financial consideration.

When you've taken out health insurance to cover eventualities like that, you don't like to think that the rules are going to be changed halfway through the game.

NICK GRIMM: Over 30 years, Ken Rice's hearing gradually gradually worsened until he was almost totally deaf.

But his life changed radically for the better when he was given a cochlear implant four years ago.

KEN RICE: At the tender age of 77, I've got to make the best use of what time I've got left.

And I am not going to be mucked about.

NICK GRIMM: Now this grandfather of nine is able to hear his youngest grandchild's first attempts at language.

KEN RICE: Yes, I'm afraid I missed out on first words and things like that with all of my grandchildren.

It's wonderful just to be able to hear those things.

Just hear the birds and hear the traffic going by.

To hear your grandchildren doing their best to make their first little speeches.

Wonderful.

NICK GRIMM: Wonderful too, is the change for 3-year-old Katie Richards, another one of the success stories of the so-called bionic ear.

MATTHEW RICHARDS, FATHER OF PATIENT: I think when you take out health insurance you're told that that's going to give you some piece of mind, like when you take out any insurance, and now, we don't have much peace of mind.

NICK GRIMM: For parents like Matthew Richards, there's concern that private health funds will no longer cover the cost of upgrading the speech processes that make cochlear implants so effective.

Upgraded speech processes have always been on the compulsory Schedule Five List, which covers items the Federal Government dictates must be automatically covered by private health funds.

But not anymore.

Last year, the Federal Government quietly removed cochlear upgrades from the Schedule Five List, effectively making it optional for health funds to cover the cost of replacing and upgrading cochlear speech processes.

PROFESSOR BILL GIBSON, CHILDREN'S COCHLEAR IMPLANT CENTRE: Well, if it goes ahead, then everybody will have to rely on the public purse to get their upgrade.

And the public purse is not big enough, so what's going to happen is, we're going to have to prioritise.

NICK GRIMM: And in future, doctors could be facing a very difficult choice.

PROFESSOR BILL GIBSON: I'm going to have to decide who gets an upgrade and who doesn't get one.

It's going to be ghastly.

So I'll say, "That chap's old, so he can't have one."

Somebody's young, "They've got to have it."

And it would just be a horrible situation.

NICK GRIMM: These children with cochlear implants are wearing the relatively bulky backpack-style speech processor.

Later they'll be eligible for the new miniaturised and more effective speech processors.

If, that is, they can get one.

PROFESSOR BILL GIBSON: People who have health insurance, imagine that they're going to be looked after for all their life with their health insurance, no matter what happens to them.

So they'll be disappointed to know that they're no longer going to be looked after if they have a hearing loss.

NICK GRIMM: The Federal Government says it will help cover the cost of providing cochlear upgrades to children and pensioners, but it already appears that won't be enough for children like Katie Richards.

MATTHEW RICHARDS: From what I've just heard recently, we're going to fall inbetween a gap of private health insurance and inadequate Government funding, which is incredibly disappointing, I think, having paid premiums for 10 years.

NICK GRIMM: Other cochlear implant recipients are just as intent on enjoying the best hearing possible.

Professionals like Defence Department information technology specialist Stephen Pascoe, whose implant has provided an array of new career possibilities.

STEPHEN PASCOE, PATIENT: We do a lot of teleconferences, we do a lot of video conferences, so I really need a high level of communication to be able to do my job.

NICK GRIMM: The latest technology would be even more useful and would allow Stephen Pascoe to hear an ordinary phone conversation.

But at a cost of around $8,000, it's out of reach.

STEPHEN PASCOE: I've been in private health fund for 20-odd years and I did some calculations last night and the amount of money that I have put into the health fund is a lot more than I've ever taken out.

NICK GRIMM: But talk to health insurance industry spokesman Russell Schneider and he points an accusing finger back at the manufacturers of the cochlear implant.

RUSSELL SCHNEIDER, AUSTRALIAN HEALTH INSURANCE ASSOCIATION: I understand the manufacturers are making quite sure that there is some agitation about this issue and I guess that's because they've got a $31 million profit to protect.

NICK GRIMM: Cochlear Limited is now one of Australia's commercial success stories, exporting its product around the globe.

RUSSELL SCHNEIDER: I think it's unfortunate that Cochlear themselves seem to be encouraging concern among families which doesn't need to be there.

It's a case, I think, with the greatest of respect, where the ABC and your program are being used to further a commercial situation as far as the manufacturer is concerned.

NICK GRIMM: Mr Schneider says individual health funds will probably provide some level of cover for cochlear implant upgrades, but first, he wants Cochlear to renegotiate the price it charges.

Today, Cochlear released this response to Mr Schneider's claims:

COCHLEAR STATEMENT: "Cochlear is not seeking any additional funding.

It is seeking to safeguard funding to patients along the lines that they have received for the past nearly 20 years.

Australian prices are below the prices set in other developed world countries.

Cochlear did not approach the ABC on this matter but the wellbeing of our patients remains our key concern."

NICK GRIMM: In the end, cochlear implant patients simply want to regain as much of their hearing as they possibly can.

Ken Rice says his granddaughter is growing up too fast to allow him to settle for anything less.

KEN RICE: She's at that delightful stage now of saying 'ball' and 'Dad' and 'Mum'.

She's having a shot at 'grandfather'.

I'll have to wait for that.

But it's a wonderful experience to be able to use your ears to appreciate somebody you love like that.